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How Yelp made me a better doctor

Medical Economics JournalSeptember 10, 2018 edition
Volume 95
Issue 17

A runner-up of the 2018 Physician Writing Contest shares how she learned from a bad review. 

The Yelp review was searing. “Dr. Kim was a horrible doctor to work with,” she wrote, “everything from the wait times to the receptionist, to the nurses, to the bedside manner of the doctors has been appalling.” The writer minced no words. In paragraph after paragraph, she skewered everything about me and my office with vehement gusto. Reading this review, I was horrified and shocked. I couldn’t recall any patient interaction that went so horribly wrong or any patient who seemed to hate me so much.

I found her record. I had seen her multiple times and in fact had prescribed her Clomid, which successfully resulted in her current pregnancy. She was an anxious person and often had questions every visit. She had even gone to the ED for some concern, where they had found nothing wrong and discharged her. On her follow-up visit, I briefly reviewed her symptoms and also found nothing concerning. I reassured her and concluded the visit. Apparently, she was irate and soon after, transferred out of our office and wrote her scathing online review. There had been no missed medical diagnosis or poor outcome, she was just furious with my interactions.

For days and even months, her words rang in my mind. I was tempted to disregard her review as just an isolated histrionic person who hated me. Maybe she didn’t like me because she was “....” (and filled in the blank with all sorts of “–ist” views). Many times, I suspect doctors blow off these negative reviews as being by one of those impossible-to-please patients. We probably even try to cheer up our colleagues or ourselves by suggesting the reviewer was emotionally unstable. The truth was, her review really hurt. I care about what my patients think and wanted them to like me.

Once my initial anger and defensiveness calmed down, instead of discrediting her review, I objectively considered all the negative things she had said. I had spent a lot of time during her gynecologic visits and her new OB visit, but her subsequent OB visits were 10-minute slots. I was more focused during these times and shifted into a more routine checklist visit. Frankly, knowing she took more time than the typical OB patient, I avoided asking open-ended questions and tried to run through her list of questions as quickly as possible.

At that time, we had also switched to an EHR and for efficiency and accurate documentation, I was typing and talking to patients at the same time. The desk was placed such that if I wanted to use it, my back was to the patient. I realized that some patients took this turning away as an outright lack of interest and empathy.

After reading her comment where she said I never looked at her, I began swiveling around to face each patient and placed the laptop on my lap. I made sure to provide regular eye contact when patients were talking, to make sure they felt heard.

As for her anger about the long wait times, I realized that too often, I was running behind a lot-spending sometimes over an hour with a distressed patient, while letting my other, on-time patients wait. When a woman scheduled for a 20-minute annual began telling me of her disintegrating marriage, I handed her Kleenex and talked without looking at the clock. When another patient told me of her teenage son’s horrific and tragic death, I just couldn’t wrap it up. How can you neatly wrap up a child’s death in 30 minutes? I hadn’t become an OB/GYN just to brush cells off someone’s cervix.

But I ran behind without regard for my other waiting patients and that too, I realized, was unfair and something I needed to change. I made up for these unscheduled extra-long visits by trying to be ultra-efficient with my other patients and especially my routine OB visits. But I realized that this could leave my other patients feeling short- changed. For me, a 30-minute annual exam is one of many that day. But for that one patient, it is often their one time a year visit with me-a precious 30 minutes carved out of 365 days. I needed to remember that.

Also through this 1-star review, I understood the power words have over people and even reputations. After reading my own review, I wouldn’t have wanted to see me either! The verbal vit- riol someone spews online in a moment of anger can have lasting effects on their target. While I rarely write online reviews, it made me think twice when tempted to vent online. Was I writing to vent or help other readers with a fair review? A fair review is measured and objective even if it isn’t positive. A vent is palpable with passion-bursting with words banged out in hell-bent fury.

Fortunately, most Yelp readers know that even 4 1/2-star restaurants get their share of 1- or 2-star rantings. It’s probably true that no one doctor can make 100 percent of their patients satisfied and happy. I also needed to accept that. On the other hand, I shouldn’t blow off every negative review as thinking the patient was crazy or had an undiag- nosed personality disorder. Online reviews are an increasingly important factor in medicine. Seventy-two percent of patients use online reviews as their initial step in finding a doctor, according to Software Advice, and 80 percent of consumers trust online reviews as much as personal recommendations according to a report by BrightLocal and the National Research Corporation.

With increasing focus on productivity, EHRs and documentation, ultimately we have less time to spend with patients. But with patient reviews being factored into provider’s evaluations, physicians are in a no-win situation.

Somehow in a shortened time slot, we need to make our patients feel listened to and their concerns adequately addressed. I once even read an article by a physician who raised his lagging ratings just by thanking each patient at every visit. Part of residency training should include a patient psychology class in how to make patients feel satisfied while actually spending less time with them.

Ralph Waldo Emerson wrote something I never forgot: “Every man I meet is my master in some point, in that I learn of him.” That quote has served me well over my career.

In every challenging interaction, in every unanticipated outcome, once my initial gut reaction subsides, I ask myself, “What, if anything, could I have done better? Is there something I need to change or improve?”

While the 1-star review hurt my feelings and my pride, it didn’t kill me or my practice, I learned from it and I grew. I still run behind often, but not to the degree I used to. I’ve learned to slow down once I step inside a room, face the patient, make eye contact and let them feel heard.

In the same way, I’m acutely aware of the other patients whose time is just as valuable, each patiently waiting for their allotted time with me. And I make sure to thank each one for waiting.

Gloria Kim, MD, is an OB/GYN in the Chicago suburb of Downers Grove, Ill., where she has practiced for eight years.

She finds caring for patients the most rewarding aspect of her work. “I love encouraging them to live healthier and happier lives,” she says.

Kim believes many members of the public mistakenly believe that doctors are all rich and live extravagant lives. “Most doctors I know work really hard and have made a lot of sacrifices to achieve and maintain their careers,” she notes.

When not at work, Kim enjoys playing the piano and the cello and cooking vegan dishes. When she retires from medicine she hopes to use her OB/GYN skills overseas, performing mission work.

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